Orly Avitzur, medical adviser to Consumer Reports, recalls that when she was a third-year medical student, her class of roughly 100 was taken to an off-site retreat where they were shown hour after hour of sexually explicit films; the viewings were followed by discussion. The goal was to desensitize the students so they would feel comfortable discussing sexuality-related issues with patients.
Three decades later, terms such as erectile dysfunction and sexually transmitted disease are part of the daily lexicon, but conversations about personal matters are no less difficult for many people to initiate in a doctor’s office. Some patients hold back out of embarrassment, and some are afraid their disclosures will be shared with others.
But keeping secrets from your doctor can hamper your care and lead to new medical problems. As for confidentiality, federal privacy rules give you rights over the release of your health information and set limits on who has access to it. Here are six subjects you should speak frankly about with your doctor.
Not long ago, a stylish 83-year-old widower came to see Avitzur about his increasing difficulty walking. He reluctantly admitted to drinking about three bourbons a day. This information was hugely important. Alcohol can damage the part of the brain responsible for equilibrium as well as the nerves in the feet that help maintain balance. It can also impair liver function, which can affect decisions on which medications to select or what dosage to prescribe.
If you have recently lost health-care benefits along with your job, you might be tempted to avoid filling a prescription, take an expired medication, skip a dose or otherwise fail to comply with your prescription, all things that 28 percent of those on medication admitted doing in a recent Consumer Reports poll. But if your doctor doesn’t know you’re doing this, he or she might assume that the medication isn’t working and change your prescription or dosage. This can lead to serious consequences in the case of blood thinners and a number of other medications. If you discuss your financial problems, your doctor might be able to refer you to discount drug programs or work with you to find more affordable but equally effective medications.
When one of Avitzur’s patients, a 42-year-old mother of four, stopped smoking several years ago, the doctor made a big fuss about it. She only learned that the patient had started smoking again when the patient confided in the doctor’s secretary. Smoking is such an important risk factor for so many diseases that Avitzur’s electronic records system prompts her to ask every patient about it during every visit. She was happy that this patient was able to quit again.
While many people worry that this might be a sign of Alzheimer’s disease, forgetfulness can also be caused by a new medication, a thyroid problem, a series of small strokes or other treatable conditions. If you let your doctor know you’re having a problem, he can do a proper investigation or, in the worst-case scenario, direct you to services to help you manage your condition.
Erectile dysfunction or the loss of libido can be related to a variety of medications, including certain psychiatric drugs, antidepressants, blood-pressure drugs, opioids and other painkillers. It also could be the primary symptom of coronary heart disease or diabetes, so a thorough examination is often in order.
No, that doesn’t mean you’re having an affair (although this might be relevant, too, if you suspect a sexually transmitted disease). It means you’re seeing another doctor or getting an alternative health treatment. Getting a second opinion is your right, but if you had tests done or medication prescribed, your regular doctor needs to know about them. And be sure to inform your doctor about any supplements or nonprescription medications you’re taking, because they might interact with your prescription drugs.